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Ototopical neomycin exposure in children with nonintact tympanic membranes

Authors

  • Almut G. Winterstein PhD,

    1. Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, U.S.A.
    2. Department of Epidemiology and Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, U.S.A.
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  • Juan M. Hincapie Castillo,

    1. Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, U.S.A.
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  • Dandan Xu MS,

    1. Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, U.S.A.
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  • Wei Liu MD, MS,

    1. Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, U.S.A.
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  • Patrick J. Antonelli MD, MS

    Corresponding author
    1. Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, U.S.A.
    • Box 100264, 1600 SW Archer Road, Gainesville, FL 32610-0264
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  • Financial support for this study was provided by the University of Florida. Dr. Antonelli has received financial support from Alcon Laboratories (grant support and honoraria for speaking engagements and advisory board service), Foresight Biotherapeutics (advisory board service), and Otonomy (advisory board service).

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Although contraindicated, neomycin otic preparations may be administered to children with nonintact tympanic membranes (TMs), such as tympanostomy tubes or TM perforations. The goal of this study was to assess the magnitude of neomycin exposure in children with nonintact TMs.

Study Design:

Retrospective drug utilization study.

Methods:

Medicaid claims data (years 1999–2006) from 28 states for children aged 0 to 18 years were analyzed to identify new cases of tube placement or TM perforation. Cases were followed for 12 months to determine neomycin otic utilization.

Results:

Of the 300,470 children with nonintact TMs, neomycin otic preparations were prescribed in 43,815 (15%). Nontoxic agents (ofloxacin or ciprofloxacin) were used in 48%. In 19%, neomycin preparations were prescribed at the day of initial nonintact TM diagnosis, 52% and 71% within the first 3 or 6 months, respectively. Neomycin otic utilization decreased from 27% in cases diagnosed in 1999 to 7% in 2005 (P < .0001).

Conclusions:

Many children with nonintact TMs receive exposure to agents with potential ototoxicity, despite the availability of safer alternatives. Further study is necessary to determine why neomycin otic preparations continue to be prescribed in the presence of nonintact TMs and if such exposure is associated with ototoxicity. Laryngoscope, 2012

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